Does oral methylprednisolone work as well as Solu-medrol to treat MS relapses?

I imagine that almost all of us that have relapsing-remitting MS have been treated with Solu-medrol (intravenous methylprednisolone). I also imagine that many of us who were treated with Solu-medrol have a horror story, or at least a complaint, about this treatment.

Yes, the effects can be almost miraculous – I have dragged myself into the clinic blind in one eye and after a one-hour infusion, I have stood up and briskly walked out with full vision. Of course, I also tasted metal and felt like I had swallowed acid, after pouring some of it on my face. I have described treatment with Solu-medrol as being like someone offering to remove a bear trap from my leg, while knowing that they are going to punch me in the face as soon as it is removed.

However, the first thought I have when I hear that I need a course of Solu-medrol is that I don’t really want to have an infusion. It may sound silly (especially from someone who injects themselves daily), but I still have anxiety about the needle being stuck into my hand. I also tend to focus on the catheter that is stuck in my hand during the whole infusion process, which starts to become extremely creepy after a couple of minutes.

Therefore, I was pretty interested to attend the session called Efficacy and safety of oral versus intravenous (IV) high-dose methylprednisolone in multiple sclerosis relapses, a randomized double blind trial (COPOUSEP) at the 2014 Joint ACTRIMS-ECTRIMS Meeting.

This trial is a “non-inferiority trial” comparing oral methylprednisolone (Prednisone) to Solu-medrol, by giving 200 patients having a relapse either 1000 mg or Prednisone or Solu-medrol for 3 days. The researchers then monitored patients to see how many patients were “improved” at 28 days after treatment, as well as looking at other factors. So that participants were not aware which treatment they were receiving, the study was a “double-dummy” design, meaning all participants were given both an infusion and capsules, one of which was a placebo.

Bottom line, there was no difference between the two treatments. Both were found to have about the same effectiveness on the following measures:

  • “Improved” at 28 days after treatment (77.7% IV, 77.9% oral)
  • 16% of patients on IV methylprednisolone needed retreatment versus 12.6% on oral treatment
  • 43% on IV treatment totally recovered versus 39% on oral treatment
  • 27.6% of people on IV treatment had another relapse after a median time of 86 days, versus 32% on oral treatment having another relapse after a median of 90.5 days

The two treatments also had very similar rates of side effects, primarily: metallic tastes, hot flashes, headache, insomnia and agitation. The last two were experienced by slightly more people in the oral treatment group.

Bottom line: I’m taking the results of this study as pretty good news, as I’m guessing that I’m not the only one who doesn’t love the infusion process. I also found it interesting that the protocol was only 3 days, which is more common in Europe, where the study was conducted, instead of the 5-day course that is typical in the United States. As the 5-day course of Solu-medrol is the oldest and most established treatment of anything MS-related in the US, it will be fascinating to see when or if this protocol is accepted by neurologists in this country.


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Julie

Julie Stachowiak, PhD

Julie is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award in the Health Category. She is an epidemiologist who is also a person living with MS, Julie has an in-depth understanding about current research and scientific developments around MS. She also has first-hand knowledge of the frustrations and anxiety surrounding the disease, as she had MS for at least 15 years before receiving a diagnosis in 2003 and has had several relapses since her diagnosis.

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    22 Comments

  • Tom   Sep 13, 2014 9:43 AM
    maybe it's time to stem cell treatment ................?
  • Stephanie   Sep 13, 2014 10:18 AM
    Methylprednisolone is generic for Medrol. Also I hate Solumedrol IVs but I would rather do that than take a fist full of corticotoid pills. Blah!
  • Joni Mercado   Sep 13, 2014 10:37 AM
    I was diagnosed with borderline MS and borderline Lyme in 1991. I had double vision which went away, after 6 mos. treatment with the intravenous antibiotic, Rocephin, for the Lyme. I felt stronger with no bad side effects.
    My insurance
  • Tracey   Sep 13, 2014 10:44 AM
    I have had so many IVs of solumedrol I have built up a lot of scar tissue anf it is difficult to get to a vein. I had an eccellen home health care nurse that could do it but when I changed to medicare I was going to have to change nurses. I was taking pulse steriods monthly and I talked to my Dr and asked him if there other options because I didn't want to go through trial and error of finding another nurse. He mentioned trying oral steroids Big dose once a month orally. And I love it. Haven't had relapse in over four years.
  • Joni Mercado   Sep 13, 2014 10:50 AM
    In 1982, I had optic neuritis which was treated with oral prednisone. My husband read on MedLine that optic neuritis should be treated with oral prednisone along with intravenous methyl prednisolone, otherwise it could become worse. Two years later, optic neuritis appeared in my other eye and was treated the same, just orally.

    Then, in 1991, I was diagnosed with borderline MS and borderline Lyme. I had double vision which went away, after 6 wks. treatment with the intravenous antibiotic, Rocephin, for the Lyme. I felt stronger with no bad side effects and my blood work was perfect. The same with two future treatments with Rocephin, first for 4 wks. and the next, for 2 weeks with same good results.

    My health insurance, at first, would only pay for 6 wks. at most, since the FDA had only approved it for Lyme, not MS.

    I believe that Lyme could be a precursor to MS since the symptoms run parallel in the same rural areas (ii.e. The Lyme could possibly alter the immune system and become MS!
  • Joni Mercado   Sep 13, 2014 10:52 AM
    In 1982, I had optic neuritis which was treated with oral prednisone. My husband read on MedLine that optic neuritis should be treated with oral prednisone along with intravenous methyl prednisolone, otherwise it could become worse. Two years later, optic neuritis appeared in my other eye and was treated the same, just orally.

    Then, in 1991, I was diagnosed with borderline MS and borderline Lyme. I had double vision which went away, after 6 wks. treatment with the intravenous antibiotic, Rocephin, for the Lyme. I felt stronger with no bad side effects and my blood work was perfect. The same with two future treatments with Rocephin, first for 4 wks. and the next, for 2 weeks with same good results.

    My health insurance, at first, would only pay for 6 wks. at most, since the FDA had only approved it for Lyme, not MS.

    I believe that Lyme could be a precursor to MS since the symptoms run parallel in the same rural areas (ii.e. The Lyme could possibly alter the immune system and become MS!
  • Joni Mercado   Sep 13, 2014 10:52 AM
    In 1982, I had optic neuritis which was treated with oral prednisone. My husband read on MedLine that optic neuritis should be treated with oral prednisone along with intravenous methyl prednisolone, otherwise it could become worse. Two years later, optic neuritis appeared in my other eye and was treated the same, just orally.

    Then, in 1991, I was diagnosed with borderline MS and borderline Lyme. I had double vision which went away, after 6 wks. treatment with the intravenous antibiotic, Rocephin, for the Lyme. I felt stronger with no bad side effects and my blood work was perfect. The same with two future treatments with Rocephin, first for 4 wks. and the next, for 2 weeks with same good results.

    My health insurance, at first, would only pay for 6 wks. at most, since the FDA had only approved it for Lyme, not MS.

    I believe that Lyme could be a precursor to MS since the symptoms run parallel in the same rural areas (ii.e. The Lyme could possibly alter the immune system and become MS!
  • Joni Mercado   Sep 13, 2014 10:52 AM
    In 1982, I had optic neuritis which was treated with oral prednisone. My husband read on MedLine that optic neuritis should be treated with oral prednisone along with intravenous methyl prednisolone, otherwise it could become worse. Two years later, optic neuritis appeared in my other eye and was treated the same, just orally.

    Then, in 1991, I was diagnosed with borderline MS and borderline Lyme. I had double vision which went away, after 6 wks. treatment with the intravenous antibiotic, Rocephin, for the Lyme. I felt stronger with no bad side effects and my blood work was perfect. The same with two future treatments with Rocephin, first for 4 wks. and the next, for 2 weeks with same good results.

    My health insurance, at first, would only pay for 6 wks. at most, since the FDA had only approved it for Lyme, not MS.

    I believe that Lyme could be a precursor to MS since the symptoms run parallel in the same rural areas (ii.e. The Lyme could possibly alter the immune system and become MS!
  • christine staffieri   Sep 13, 2014 11:42 AM
    I was diagnosed in 1982,im 51 yrs old, I am now in a wheelchair for the past two yrs, why wont my doc put me on steroids, could it be because I am a 10 yr survivor breast cancer, I also have osteoporosis and arthritis,
  • christine staffieri   Sep 13, 2014 11:42 AM
    I was diagnosed in 1982,im 51 yrs old, I am now in a wheelchair for the past two yrs, why wont my doc put me on steroids, could it be because I am a 10 yr survivor breast cancer, I also have osteoporosis and arthritis,
  • Anybeth   Sep 13, 2014 3:23 PM
    Hm, so the insomnia and agitation were higher on the oral steroids. I wonder how the rates of steroid psychosis compared if that effect was common enough to measure.

    If I needed steroids, I'd much rather have a 3-day course of pills (plus step-down pack?) than 3-5 day course of IV steroids. Especially if the steroids had to be inpatient. Too busy, too bright, too loud... and they tend to stick you at 5 in the morning and somehow think it's good to give steroid infusions during meals.

    @christine staffieri: Steroid-induced osteoporosis can be a side-effect of such drugs even in people with no history of osteoporosis. Increased bone loss and greater risk of fractures could be a reason. And steroids may make bad combinations with other medicines you might already be taking.
  • Erika Faber   Sep 13, 2014 10:07 PM
    Usually, I have 2-4 treatments of IV solu methlprednisone, followed by the oral steroid. I DISLIKE the oral steroids more than the three day, high dose IV Steroids. With the oral, I get irritable, agitated, cannot sleep, itchy, metallic taste in mouth, but seriously, nothing tastes good while on either oral or IV. Also, while in oral, I get horrible heat flashes and am not yet near menopause. I hear steroids, I cringe. They do a little to help, but at this stage of the disease, it is not worth it. I usually develop kidney stones weeks to a few months after infusion. Not fun. SPMS, not the best treatment, but for a little pick me up when needed, desperation wins! I need to get through family holidays, events, and functions for my kids. All in all, steroids suck, and am looking forward to stem cell therapy, hopefully!
  • Erika Faber   Sep 13, 2014 10:09 PM
    Usually, I have 2-4 treatments of IV solu methlprednisone, followed by the oral steroid. I DISLIKE the oral steroids more than the three day, high dose IV Steroids. With the oral, I get irritable, agitated, cannot sleep, itchy, metallic taste in mouth, but seriously, nothing tastes good while on either oral or IV. Also, while in oral, I get horrible heat flashes and am not yet near menopause. I hear steroids, I cringe. They do a little to help, but at this stage of the disease, it is not worth it. I usually develop kidney stones weeks to a few months after infusion. Not fun. SPMS, not the best treatment, but for a little pick me up when needed, desperation wins! I need to get through family holidays, events, and functions for my kids. All in all, steroids suck, and am looking forward to stem cell therapy, hopefully!
  • Hummingbird   Sep 15, 2014 11:56 PM
    I participated in the ASSERT trial that looked at the safety and efficacy of high dose oral prednisone. I was in the treatment arm and every four months I swallowed TWENTY FIVE 50mg prednisone pills. (1250mg prednisone is equivalent to 1g Solu Medrol.) I have taken prednisone (AND IV Solu Medrol) many times before for severe asthma. However, the side effects from this high of a dose were almost unbearable....skin crawled, severe insomnia (even Ambien didn't really help), vivid violent dreams, acid reflux/nausea/vomiting (despite taking Zantac), and anger/moodiness. A taper wasn't allowed in the study, so I had withdrawal which lasted about 5 days....I felt HUNG OVER, and the withdrawal was actually worse than the treatment!

    Rachel - pharmacist with MS.
  • Paul a   Sep 18, 2014 6:35 AM
    I guess dr Becks research many moons ago didn't fetch up
  • Gusztav   Sep 18, 2014 7:47 AM
    Diagnosed with MS after going to 8 different Doc's to find out what was wrong with me. Had 1 strain of Lime, was given antibiotics as a precaution. I lost use of my legs from the hip down. The neurologist gave me the 5 day treatment of solu-medrol IV. Used a wheelchair for a month, then a walker, then continued with copaxone.. Later oral Prednisone on a taper for future issues. I went through solu-medrol and chemo one a month for 6 months at a time, 6 on, 6 off... This was very expensive and the insurance wouldn't pay anything.... I went back to the oral Prednisone, take Betaseron, and relapses have been a stranger but my body is tired and I have zero indurance, LOL, I can still walk, cook, clean a bit and cut my grass.... Don't ever give up!!!!!!!!!!!!! :)
  • Paso_Cook  Sep 18, 2014 11:16 AM
    Orals did little to help my attacks, so I was interested to see the results of a 3-day IV pulse when the need arose. Great results, few side effects and, more importantly, the infusion cured a 5-month long Meniere's attack. Meniere's stole hearing in 1 ear yrs ago & I was deaf for 5 months (no exaggeration) & suffering from a number of other Meniere's symptoms. Orals never helped w/the hearing/vertigo issues either. 8 days after the infusion, my hearing improved & has been very good for over 2-1/2 years! NO vertigo either. So, I rec'd a 2-for-1, the MS attack was alleviated and Meniere's virtually cured (I've suffered w/Meniere's for decades)! I'll take the IV any time & have reported to my Neurologist & Otologist these results hoping the IV option could help other patients.
  • docdc1  Sep 25, 2014 3:48 PM
    I was diagnosed 2 years ago and have had IV steroids twice. The last time I developed chest pain just after the IV ended. It works to help relieve symptoms but the side effects are awful
  • KRAZE   Oct 29, 2014 4:35 PM
    I just started a 3 day iv solumedrol treatment for an MS exacerbation. I live in USA-Michigan. My neurologist gives 3 day infusions with no oral taper. I don't like to have to do the steroids, and hate all the things mentioned above, but when a flare up "gets my legs" as I say, it's so worth it to be able to walk and feel better. Personally..I refuse to go in a wheel chair, no matter how much it hurts to walk. I was told once by my physical therapist once during rehab to build up my muscles from flare to ."NEVER GIVE UP! "
  • michelle (meche)   Oct 31, 2014 12:33 PM
    First of all I want to say thank you for the research that has been done. I have taken Solu-Medrol by IV too many times. I am happy to hear that there's not much of a difference between the two avenues. I now resort to Solu-Medrol often because I've literally tried everything that's been out on the market right up to the latest oral treatment. None of which have well for me either due to complications, untoward effects, or insurance issues. Here is the list of everything I've been on. avonex, betaseron, Copaxone , rituxin, novatrone, Cytoxin, tysabri, IvG (my favorite but too costly), plasmapheresis (I would definitely do this again if insurance would approve it), Techfidera, and Aubagio, Can somebody please help me and tell me what to do next. yikes. Both of the neurologist I've been seen are literally moving out of the state at the same time. I think I have a new one in mind, but this is not the time for an intense exacerbation. Btw, with the medications most of the discontinuing of those were decided by the doctors.
  • Jessica Koock   Jun 5, 2017 8:09 PM
    I am likely having a relapse, and so will be starting steroid tomorrow. Because of your blog post, and because I feel the same way about infusions as compared to oral medicines, I'm going to have the methyl prednisone. My doctor is suggesting a five-day course, and I will see how I feel after 3 days taking this. Thank you for this valuable information
  • Jessica Koock   Jun 5, 2017 8:23 PM
    I am likely having a relapse, and so will be starting steroid tomorrow. Because of your blog post, and because I feel the same way about infusions as compared to oral medicines, I'm going to have the oral methyl prednisone. My doctor is suggesting a five-day course, and I will see how I feel after 3 days taking this. Thank you for this valuable information